Selective revascularization of hepatic artery thromboses after liver transplantation improves patient and graft survival.

摘要: BACKGROUND Hepatic artery thrombosis (HAT) can be a devastating complication of orthotopic liver transplantation (OLT), but early diagnosis may allow successful revascularization and graft salvage. METHODS We reviewed data on 1,026 transplants at our institution. For patients in whom HAT was diagnosed within 30 days after OLT, we recorded indications for ultrasonography function tests diagnosis, management HAT, patient survival. RESULTS Thirty-two (3.1%) developed 6.8+/-6.6 (range, 1-29 days) OLT. Twelve (37.5%) were asymptomatic diagnosis. In 11 these 12, routine duplex 2.0+/-1.55 OLT; the 12th patient, noted during re-exploration unrelated bleeding postoperative day 3. Eleven 12 (91.6%) revascularized; one (8.4%) received no treatment with sequelae. Of who revascularized, 9 (81.8%) had salvage 2 (18.2%) second transplant, death. Twenty (62.5%) symptomatic. 20, 9.85+/-6.93 Symptoms were: elevated test results (serum glutamic oxaloacetic transaminase: 722+/-1792 U/ml, serum pyruvic 678+/-963 bilirubin: 10.2+/-6.2 mg/dl) 13 (65%); bile leak 4 (20%), sepsis 3 (15%). Five 20 (25%) 5, (40%) salvage, transplant 1 death, (20%) died abscess. symptomatic (60%) immediate re-OLT; 10/12 are alive, sepsis, late causes. Three treatment; two biliary survived. Overall 83.3% 15% symptoms (P<0.001). Graft undergoing 81.8%, versus 40% (P=NS). One-year survival 91.7% 65% (with death excluded) CONCLUSIONS Routine should performed transplantation. believe that emergent hepatic retransplantation lead to improved relatively low incidence complications.